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Differential expression of the CCN family members Cyr61, CTGF and Nov in human breast cancer
Wen G Jiang, Gareth Watkins, Oystein Fodstad 1, Anthony Douglas-Jones 2, Kefah Mokbel 3 and Robert E Mansel
Metastasis & Angiogenesis Research Group, University of Wales College of Medicine, Cardiff University, Cardiff, UK 1Cancer Research Institute, University of South Alabama, Mobile, AL, USA 2Pathology, University of Wales College of Medicine, Cardiff University, Cardiff, UK 3Department of Surgery, St George Hospital, London, UK
(Requests for offprints should be addressed to W G Jiang; Email: [email protected])
Abstract
The CCN family members cysteine-rich 61 (Cyr61/CCN1), connective tissue growth factor (CTGF/ CCN2) and nephroblastoma over-expressed (Nov/CCN3) play diverse roles in cells, are known to regulate cell growth, adhesion, matrix production and migration and are involved in endocrineregulated pathways in various cell types. The role of these molecules in cancer remains controversial. In a cohort of 122 human breast tumours (together with 32 normal breast tissues) we have analysed the expression of all three CCN members at the mRNA and protein levels. Significantly higher levels of Cyr61 ðP ¼ 0:02Þ, but low levels of CTGF and Nov, were seen in tumour tissues compared with normal tissues. Significantly raised levels of Cyr61 were associated with poor prognosis ðP ¼ 0:02Þ, nodal involvement ðP ¼ 0:03Þ and metastatic disease ðP ¼ 0:016Þ. Patients who died of breast cancer also had high levels of Cyr61. In contrast, CTGF in patients with poor prognosis ðP ¼ 0:021Þ, metastasis ðP ¼ 0:012Þ, local recurrence ðP ¼ 0:0024Þ and mortality ðP ¼ 0:0072Þ had markedly reduced levels. Similar to CTGF, low levels of Nov were also seen in patients with poor prognosis and mortality and with significantly decreased survival (P ¼ 0:033 and P ¼ 0:0146, respectively). This result was fully supported by immunohistochemical analysis of frozen sectioned tissues. While fibroblasts and endothelial cells generally expressed good levels of all three CCN proteins, highly invasive MDA MB 231 cells expressed lower levels of CTGF and Nov, but higher levels of Cyr61, than the less invasive MCF-7. It is concluded that members of the CCN family are differentially expressed and may play important but contrasting roles in the progressive nature of human breast cancer. While Cyr61 appears to act as a factor stimulating aggressiveness, CTGF and Nov may act as tumour suppressors.
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activities probably occur through the ability of CCN
Introduction
proteins to bind and activate cell-surface integrins and
The CCN family comprises cysteine-rich 61 (Cyr61/ CCN1), connective tissue growth factor (CTGF/CCN2) and nephroblastoma over-expressed (Nov/CCN3). Recently the Wnt-induced secreted proteins (WISPs) have been found to also belong to the CCN family and so WISP-1 has been named CCN4, WISP-2 is CCN5 and WISP-3 is CCN6. These proteins stimulate mitosis, adhesion, apoptosis, extracellular matrix production, growth arrest and migration of multiple cell types (for a recent review, see Brigstock 2003). Many of these intracellular signalling molecules including fibulin 1C, Notch 1, S100A4 and ion channels (Perbel 2004). Accumulating evidence supports a role for these factors in endocrine pathways and endocrine-related processes. Despite the progress in understanding the biology of these molecules in cells and signalling pathways, the role of the CCN members in cancer is far from clear and the results in the literature remain controversial.
Cyr61 is a known angiogenic factor (Babic et al. 1998,
Mo et al. 2002), which acts probably by regulating pro-
Endocrine-Related Cancer (2004) 11 781–791
1351-0088/04/011–781 # 2004 Society for Endocrinology Printed in Great Britain
DOI:10.1677/erc.1.00825
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Jiang et al.: CCN family in human breast cancer
Table 1 Clinical information on patients in the study
exhibited lower levels in breast tumours and were inversely linked to a poor prognosis, suggesting that differentially expressed CCN members may have clear contrasting roles in the development of human breast cancer.
Clinical Information
n
- Nodal status
- Negative
Positive
65 55 23 41 56 69 60
7
- Grade
- Grade 1
Grade 2
Materials and methods
Sample collection
Grade 3
- TNM-1
- TNM staging
Human breast cancer cell lines MCF-7 and MDA MB 231, and human fibroblast cell line MRC-5, were purchased from the European Collection of Animal Cell Cultures (ECACC, Salisbury, Hants, UK). Human umbilical vein endothelial cells (HUVECs) were purchased from TCS Biologicals (Oxford, UK). Breast cancer tissues ðn ¼ 120Þ and normal background tissues ðn ¼ 32Þ were collected immediately after surgery and stored in a deep freeze until use. Patients were routinely followed clinically after surgery. The median follow-up period was 72 months for the current study. The presence of tumour cells in the collected tissues was verified by a consultant pathologist (A D-J), who examined Hematoxylin and Eosin (H&E)-stained frozen sections. Details of the histology were obtained from pathology reports and have been given in Table 1.
TNM-2 TNM-3
- TNM-4
- 4
- Clinical outcome
- Disease-free
With metastasis With local recurrence Died of breast cancer
87
65
19
angiogenic integrins (Tsai et al. 2000, Leu et al. 2002). MCF-7 breast cancer cells, when transfected with Cyr61, acquire hormone independence and anti-oestrogen resistance. These cells become tumorigenic and invasive, accompanied by increased angiogenic activities. Cyr61 has been indicated in tumorigenesis and disease progression in breast tumour models (Tasi et al. 2002a). Cyr61 expression can be up-regulated by hormones such as progestin (Sampath et al. 2002), and agents including phorbol ester and vitamins D and E2 (Sampeth et al. 2001, Tsai et al. 2002b), but down-regulated by retinoic acid (Tsai et al. 2002b). The role for CTGF/CCN2 in cancer is far less clear. CTGF has been shown to affect cell-cycle progression, by up-regulating cyclin A and reducing p27kip1 (Kothapalli and Grotendorst 2000). CTGF has been found to be highly expressed in proliferating endothelial cells and glioma cells (Pan et al. 2002). In breast cancer cells, CTGF mRNA was found to be absent from MCF-7. Transfection of MCF-7 with CTGF expression vector results in a high degree of apoptosis (Hishikawa et al. 1999). This has been supported partly by a recent study which shows that over-expression of CTGF in oral squamous cell carcinoma results in reduction in cell growth and tumorigenesis (Moritani et al. 2003). Nov/CCN3 is probably the least-studied CCN member. Nov has been indicated to stimulate the proliferation of fibroblasts (Liu et al. 1999). Over-expression of Nov in glioma cells results in cells with slower growth rate and low tumorigenicity (Gupta et al. 2001).
Materials
RNA-extraction kit and RT kit were obtained from AbGene, Guildford, Surrey, UK. PCR primers were designed using Beacon Designer (Palo Alto, CA, USA) and synthesized by Invitrogen (Paisley, Scotland, UK). Molecular-biology-grade agarose and DNA ladder were from Invitrogen. Mastermix for routine PCR and quantitative PCR was from AbGene. Goat anti-human Cyr61, CTGF and Nov antibodies were purchased from Santa Cruz Biotechnology (Santa Cruz, CA, USA).
Tissue processing, RNA extraction and cDNA synthesis
Frozen sections of tissues were cut at a thickness of 5– 10 mm and kept for immunohistochemistry and routine histology (Jiang et al. 2003a). A further 15–20 sections were homogenized using a hand-held homogenizer in icecold RNA extraction solution. The concentration of RNA was determined using a UV spectrophotometer. Reverse transcription was carried out using an RT kit with an anchored oligo-dT primer supplied by AbGene, using 1 mg total RNA in a 96-well plate. The quality of cDNA was verified using b-actin primers.
Thus, the role of the CCN family in clinical cancer is unclear and in many cases remains controversial. In the current study, we have examined the relationship between Cyr61, CTGF and Nov at the mRNA and protein levels in a cohort of human breast cancer, and studied the clinical outcomes. We report here that while Cyr61 was highly over-expressed in tumour tissues and was linked to the progressive nature of breast tumours, CTGF and Nov
Quantitative analysis of CCN family members
The transcript level of the CCN family members from the above-prepared cDNA was determined using a real-time
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Endocrine-Related Cancer (2004) 11 781–791
quantitative PCR, based on the AmplifluorTM technology (Nazarenko et al. 1997), modified from a previously reported method (Jiang et al. 2003a, 2003b). Briefly, a pair of PCR primers was designed using the Beacon Designer software (version 2). To one of the primers (routinely the antisense primer in our laboratory), an additional sequence, known as the Z sequence (50- ACTGAACCTGACCGTACA-30), which is complementary to the universal Z probe (Nazarenko et al. 1997; Intergen, Oxford, UK), was added. A Taqman detection kit for b-actin was purchased from Perkin-Elmer. The primers used were: Cyr61, 50-GGGCTGGAATGCAA CTTC-30 and 50-ACTGAACCTGACCGTACACGTT TTGGTAGATTCTGGAG-30 (spanning the third intron; GenBank accession no. AF307860); CTGF, 50-GAGT GGGTGTGTGACGAG30 and 50-ACTGAACCTGACC GTACAGGCAGT- TGGCTCTAATCATA-30 (spanning the fourth intron; NM_001901); and Nov, 50-CTGTGAA al. 2003c). The sections were mounted on Super Frost Plus microscope slides, air dried and then fixed in a mixture of 50% acetone/50% methanol. The sections were then placed in Optimax wash buffer for 5–10 min to rehydrate. Sections were incubated for 20 min in a 0.6% BSA blocking solution and probed with the primary antibody. Following extensive washings, sections were incubated for 30 min with the secondary biotinylated antibody (Multilink Swine anti-goat/mouse/rabbit immunoglobulin; Dako, Ely, Cambs, UK). Following washings, avidin–biotin complex (Vector Laboratories, Burlingame, CA, USA) was then applied to the sections followed by extensive washings. Diaminobenzidine chromogen (Vector Laboratories) was then added to the sections, which were incubated in the dark for 5 min. Sections were then counterstained in Gill’s haematoxylin and dehydrated in ascending grades of methanol before clearing in xylene and mounting under a cover slip. Cytoplasmic staining of the respective proteins was quantified using Optimas 6.0 software as we described previously (Davies et al. 2000, King et al. 2004) and is shown here as relative staining intensity.
- CAAGAGCCAGAG-30
- and
- 50-ACTGAACCTGA
CCGTACACTTGAACTGCAGGTGGAT-30 (spanning positions 848–849; NM-002514). Primers used for quantitation of oestrogen receptor (ER) and ER-b were as reported previously (Ye et al. 2003): ER, 50-CCTAC TACCTGGAGAACGAG-30 and 50-CTCTTCGGTCTT TTCGTATG-30; and ER-b, 50-AAAAGAATCATTCA ATGACA-30 and 50-ATTAACACCTCCATCCAACA- 30. Cytokeratin-19 (CK19) was used for comparison of cellularity during the analysis and primers for CK19 were 50-CAGGTCCGAGGTTACTGAC-30 and 50-ACTGAA CCTGACCGTACACACTTTCTGCCAGTGTGTCTTC -30 (King et al. 2004, Parr and Jiang 2004).
Statistical analysis was carried out using Mann–
Whitney U test, the Kruskal–Wallis test and survival analysis using Kaplan–Meier survival curves and Univariate analysis (SPSS11).
Results
Expression of CCN members in breast tissues
Using quantitative PCR, it was shown that Cyr61 displayed significantly higher levels in tumour tissues compared with normal tissues (Fig. 1). In contrast, levels of CTGF were significantly lower in tumour tissues than in normal tissues. The levels of Nov (CCN3) were also low in tumour tissues, but the difference was not statistically significant. When the levels of the transcripts were normalized by CK19, as revealed by the CCN:CK19 ratio (Fig. 1, inserts), similar trends were seen with respective molecules.
The reaction was carried out using the following: Hotstart Q-master mix (Abgene), 10 pmol of specific forward primer, 10 pmol of reverse primer which has the Z sequence, 100 pmol of 6-carboxyfluorescein (FAM)- tagged probe (Intergen), and cDNA from approximately 50 ng RNA (calculated from the starting RNA in the reverse transcriptase reaction). The reaction was carried out using IcyclerIQTM (BioRad) which is equipped with an optic unit that allows real-time detection of 96 reactions, using the following conditions: 948C for 120 min, 50 cycles of 948C for 150 s, 558C for 400 s and 728C for 200 s (Jiang et al. 2003b, 2003c, Parr and Jiang 2004). The levels of the transcripts were generated from an internal standard (Jiang et al. 2003a) that was simultaneously amplified with the samples, and are shown here in two ways: levels of transcripts based on equal amounts of RNA, and as a target/CK19 ratio.
Distribution of CCN members in different cell types
In immunohistochemical analysis, strong Cyr61 staining was seen in both cancer cells and endothelial cells in tumour tissues (Fig. 2A & B). In contrast, the staining of both cell types in normal tissues was visibly weaker than in cancer cells (Fig. 2A). The staining pattern of CTGF was in clear contrast with Cyr61, in that CTGF strongly stained normal epithelial cells, stromal cells and endothelial cells, but only weakly stained cancer cells (Fig. 2C & D). However, it is noteworthy that matrix in tumour
Immunohistochemical staining of the CCN family proteins
Frozen sections of breast tumour and background tissue were cut at a thickness of 6 mm using a cryostat (Jiang et
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Jiang et al.: CCN family in human breast cancer
Figure 1 Levels of expression of Cyr61 (left-hand panel), CTGF (middle panel) and Nov (right-hand panel) in normal and tumour tissues. ÃP < 0:05 compared with normal tissues. Inserts: Cyr61:CK19, CTGF:CK19 and Nov:CK19 ratios.
tissues exhibited some degree of staining. The pattern of Nov staining was similar to that of CTGF (Fig. 2E & F). Fig. 3 shows the quantitative analysis of cytoplasmic staining of normal mammary epithelial cells and breast cancer cells, using image analysis. Protein levels of Cyr61 were significantly higher in cancer cells compared with normal mammary epithelial cells. In contrast, both CTGF and Nov proteins were seen at lower levels in breast cancer cells (Fig. 3, middle and right-hand panels).
To further verify the cell source of these molecules, we measured the levels of transcripts in highly aggressive MDA MB 231 and less-invasive MCF-7 breast cancer cells, MRC5 fibroblasts, and HECV and human umbilical vein endothelial cells (HUVEC) endothelial cells. Both fibroblasts and endothelial cells expressed high levels of all three members. The expression patterns of Cyr61 and those of CTGF and Nov were very different in breast cancer cell lines. The highly invasive MDA MB 231 cells expressed high levels of Cyr61, but relatively lower levels of CTGF and Nov, when compared with non-invasive MCF-7 cells. panel). No significant difference was seen for the Nov transcript between different groups (Fig. 4, right-hand panel; P ¼ 0:07, NPI-3 compared with NPI-1). Similar trends were seen when the target:CK19 ratio was assessed (Fig. 4, inserts).
Cyr61 was expressed at significantly higher levels in node-positive tumours compared with node-negative tumours (P ¼ 0:034; Fig. 5, left-hand panel). Although node-positive tumours had higher levels of CTGF than node-negative ones (Fig. 5, middle panel), the difference was not statistically significant. No difference of Nov transcripts was seen between node-positive and -negative tumours (Fig. 5, right-hand panel). The same changes were also seen with the CCN:CK19 ratio (Fig. 5, inserts).
Levels of CCN members and relationship with TNM staging and tumour differentiation
Cyr61 was highly expressed in TNM-3/4 tumours (Fig. 6, left-hand panel), compared with TNM-1 tumours (P ¼ 0:05 and 0.106 respectively). A marginal and nonsignificant reduction of CTGF was seen in TNM-2/3/4 tumours, compared with TNM-1 tumours (Fig. 6, middle panel). The changes of Nov transcripts were similar to those of CTGF, except that TNM-4 tumours had significantly lower levels of Nov compared with TNM-1 tumours (P ¼ 0:0048; Fig. 6, right-hand panel). Similar trend of changes in each molecule were seen when the CCN:CK19 ratios were compared (Fig. 6, inserts).
Grade 2 and grade 3 tumours have significantly higher levels of Cyr61, compared with grade 1 tumours (Table 2). Although levels of CTGF and Nov in grade 3 tumours were generally low compared with grade 1 tumours, this difference is nonetheless not statistically significant (Table 2).
Levels of CCN members and relationship with prognostic indices and nodal involvement
The prognosis indices used here were 2-fold; nodal status and the Nottingham Prognostic Index (NPI; where NPI-1 represents patients with NPI<3.5 and good prognosis, NPI-2 is 3.5–5.4 with moderate prognosis, and NPI-3 is > 5.4 with poor prognosis).
Significantly higher levels of Cyr61 were seen in NPI-3 tumours when compared with NPI-1 tumours (P ¼ 0:02; Fig. 4, left-hand panel). Although Cyr61 was higher in NPI-2 tumours, the difference between NPI-1 and NPI-2 was nonetheless not significant. In contrast to Cyr61, CTGF was significantly lower in NPI-3 tumours (P ¼ 0:021 compared with NPI-1 tumours; Fig. 4, middle
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Endocrine-Related Cancer (2004) 11 781–791
Figure 2 Immunohistochemical staining of Cyr61 (A, B), CTGF (C, D) and Nov (E, F) in normal (A, C, E) and tumour (B, D, F) tissues. Shown are magnifications Â100 (main panels), and Â400 (inserts).
Correlation between levels of CCN members and ER status
tumours ðr ¼ ꢀ0:32Þ, and CTGF and Nov in TNM-3 tumours (r ¼ ꢀ0:40 and r ¼ ꢀ0:58, respectively), and Nov in TNM-4 tumours ðr ¼ ꢀ0:76Þ. The correlations between ER-b and the CCN members revealed an inverse correlation with all three members in tumours which developed metastasis (r ¼ ꢀ0:32 for Cyr61, r ¼ ꢀ0:39 for CTGF and r ¼ ꢀ0:49 for Nov, respectively).
The possible relationship between CCN family members and ER status was also analysed. There was no significant correlation between ER and ER-b with any of the family members when tumours were analysed as an entire cohort. However, ER was inversely correlated with Nov in NPI-3
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Jiang et al.: CCN family in human breast cancer
Figure 3 Staining intensity of normal mammary epithelial cells and breast cancer cells in mammary tissues. Cyr61 is shown on the left, CTGF in the middle and Nov on the right. Cytoplasmic staining of the respective molecules was analysed using Optimas 6 and is shown as relative staining intensity. ÃP < 0:05 compared with normal epithelial cells.
Figure 4 Expression of Cyr61 (left-hand panel), CTGF (middle panel), and Nov (right-hand panel) in relation to the Nottingham Prognostic Index (NPI), where NPI-1 ð< 3:4Þ indicates good prognosis, NPI-2 (3.4–5.4) is moderate and NPI-3 ð> 5:4Þ is poor prognosis. ÃP < 0:02 compared with NPI-1. Inserts: respective CCN:CK19 ratios.
CCN and clinical outcome
compared with those groups with incidence (a combination of the other three groups). As shown in Fig. 7 (lefthand panel), patients with metastasis had significantly higher levels of Cyr61 ðP ¼ 0:016Þ. A marginally high level of the molecule was also seen in those who had recurrence and mortality. The Cyr61:CK19 ratios were 193 Æ 120, 3145 Æ 1311, 31466 Æ 15670 and 2951 Æ 1169
Following a 6-year follow up, patients were divided into four groups; those who remained disease-free, developed metastasis, had local recurrence and those who died of breast cancer (excluding deaths unrelated to breast cancer). In addition, the disease-free group was also
Figure 5 Levels of expression of the CCN family members in node-negative and node-positive tumours. Significantly high levels of Cyr61 were seen in node-positive tumours ðÃP ¼ 0:034Þ. Inserts: respective CCN:CK19 ratios.
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Figure 6 Levels of expression of Cyr61, CTGF and Nov in relation to TNM staging. Significantly higher levels of Cyr61 was seen in TNM-3 tumours ðÃP ¼ 0:05Þ and non-significant high level in TNM-4 tumours ðP ¼ 0:106Þ compared with TNM-1 tumours. Significantly lower levels of Nov were seen in TNM-4 tumours compared with TNM-1 ðÃP ¼ 0:0048Þ. Inserts: respective CCN:CK19 ratios.